Healthcare Provider Details

I. General information

NPI: 1205269636
Provider Name (Legal Business Name): FLORENCE SCHOOL DISTRICT # 5
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2013
Last Update Date: 08/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 E MARION ST
JOHNSONVILLE SC
29555-6517
US

IV. Provider business mailing address

160 E MARION ST
JOHNSONVILLE SC
29555-6517
US

V. Phone/Fax

Practice location:
  • Phone: 843-380-0798
  • Fax:
Mailing address:
  • Phone: 843-380-0798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number9589
License Number StateSC

VIII. Authorized Official

Name: MR. RANDY SMILEY
Title or Position: SUPERINTENDENT
Credential:
Phone: 843-386-2358